Tobacco Dependence - Traditional Pharmacotherapy
Our first nicotine patch study in 1988 helped to establish the efficacy of this therapy, and in subsequent studies, we better defined the doses needed to adequately treat patients with tobacco dependence. We have also investigated other nicotine replacement therapies including the nicotine inhaler, nicotine nasal spray, nicotine gum, and nicotine lozenge as well as multiple non-nicotine medications. The CPC's research team of Richard Hurt, M.D., Lowell Dale, M.D., and Ivana Croghan, Ph.D., was the lead group for a pivotal trial that led to bupropion approval in 1997. Dr. Dale recently completed two studies testing the efficacy of the cannabinoid receptor inhibitor rimonabant in treating tobacco dependence, and in the past five years we have extended our close collaborations with our colleagues in the Department of Laboratory Medicine to develop the capabilities of assaying biological fluids for tobacco alkaloids. This began with work in the 1980s and 1990s using HPLC methodology to measure nicotine and cotinine in saliva, serum, and urine. This has evolved into more sophisticated assays using GC mass spectrometry.
Alcoholic Smokers
The prevalence of smoking in alcoholics is two to three times that of the general population. Drs. Hurt and I. Croghan in our group, with the collaboration of L. Joseph Melton III, M.D., produced a seminal paper with NIDA support which showed that the mortality following treatment for alcoholism was much higher than expected for the general population, but the extensive burden of tobacco-caused disease accounted for over 50 percent of all deaths, while alcohol-caused disease accounted for 34 percent. This paper has had a major impact on the addictions treatment field, which up until that time rarely addressed tobacco dependence in patients undergoing treatment for alcohol dependence. This led to an NIAAA-funded study, "Pharmacologic Relapse Prevention for Alcoholic Smokers," into which Drs. Hurt and I. Croghan, along with Christi Patten, Ph.D., and J. Taylor Hays, M.D., enrolled 195 recovering alcoholics and provided tailored nicotine replacement therapy for the first seven weeks, which proved quite effective.
Smokeless Tobacco Dependence
Smokeless tobacco use is a major health and addiction problem, particularly for adolescent and young adult males. According to the 1999 U.S. National Household Survey of Drug Abuse, an estimated 7.6 million people 12 years of age and older, currently use smokeless tobacco. Long-term smokeless tobacco use increases the risk of developing oral leukoplakia, oropharyngeal cancer, and periodontal diseases. While few intervention studies for smokeless tobacco users have been conducted, Jon Ebbert, M.D., has conducted a range of research projects over the past several years, leading to a broad experience in the clinical treatment of smokeless tobacco users. Dr. Ebbert and team have conducted a clinical trial investigating the efficacy of high dose nicotine patch therapy (up to 63 milligrams (mg)/day) in smokeless tobacco users. In this study, Drs. Ebbert and Patten, also validated a dependence measure for smokeless tobacco users, the Fagerström Test for Nicotine Dependence for smokeless tobacco users. Drs. Dale, Ebbert, I. Croghan, and Hurt have also conducted a study of bupropion SR for smokeless tobacco users, concluding that bupropion SR significantly decreased craving and weight gain over the treatment period, although it did not significantly increase tobacco abstinence rates among smokeless tobacco users.
